Organization Name: | DR AL VILLALOBOS |
NPI Number: | 1396100830 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAWN CONRAD (MANAGER) |
Mailing Address: | 1620 N Us Highway 1 Suite 6 Tequesta |
State: | FL US |
Postal Code: | 334693228 |
Phone Number: | 5617440677 |
Fax Number: | 5617439067 |
NPI Enumeration Date: | 12/29/2015 |
NPI Last Update Date: | 12/29/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 251K00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Agencies |
Taxonomy Classification: | Public Health or Welfare |
Taxonomy Specialization: | |
Taxonomy Definition: |